More than 3,000 recorded cases and 2,006 cases of Ebola deaths are too many. It is in these terms that Martin FAYULU MADIDI reacts to the unfortunate consequences of this terrible epidemic. He calls on the people of North Kivu and Ituri to observe the hygiene measures recommended by the medical staff.

According to the President of the Dynamic Truth of the Urns, DVU, even if a year is already endured under the Ebola virus disease in North Kivu and Ituri, hope is still possible with the advent of Dr. MUYEMBE.

During a telephone interview with RMBB on Saturday, August 24, Martin FAYULU calls the inhabitants to observe the hygiene measures recommended by the medical staff.

"You always have to have hope. If there is no hope, it means that our people are doomed. That's why I started raising awareness. I went to Butembo last February. I told the people there to be careful that Ebola exists and take all precautions. I saw Monseigneur, I saw the others, I was in the center of response ... I continued to say that we must eradicate Ebola. Now we must all put our hands to the job so Ebola is eradicated permanently," sensitized Martin FAYULU ,who continues to regret that the people of Butembo and Beni were removed from the elections of December 2018.

Whether by microbial mutation, movement across borders, or man-made biological release, a new health threat is inevitable, unpredictable and potentially devastating. For the first time, the world now has a clear picture of how prepared countries are for this potentially catastrophic event.

When the international evaluation team left Haiti in July 2019, one hundred countries had completed a Joint External Evaluation (JEE) of health emergency readiness. The JEE is a voluntary, externally validated assessment of 19 technical areas required to prevent, detect and respond to health emergencies. This milestone, in addition to the ongoing uncontrolled Ebola epidemic in the Democratic Republic of Congo, makes this an opportune time to take stock of both the status of the world’s preparedness and of what needs to be done to make the world safer.

When the JEE process began in 2016, many doubted that countries would be willing to openly share information, or that the evaluations would be consistent. Fortunately, these concerns were unfounded: countries—including nearly every country in Africa—were eager to participate and openly shared detailed information on their strengths and weaknesses. International teams, using standard measures, created a consistent rating system. The results are in. JEEs have documented that, despite the certainty that the world will face another epidemic challenge at least as great as recent outbreaks of severe acute respiratory syndrome, H1N1 influenza, Middle East respiratory syndrome, Ebola and Zika, most countries remain woefully underprepared to manage large-scale epidemic disease threats.

The first 100 JEEs lead to three overarching conclusions. First, no country is fully prepared to manage disease epidemics (figure 1). Second, the number of preparedness gaps, and the resulting to-do list of actions to take to fill them, is overwhelming: more than 7000 priority tasks await action. Third, JEEs have diagnosed preparedness gaps well, but few of these gaps have been filled. To make the world safer, global institutions, partner countries and organisations, and countries themselves must follow the assessments with urgent action to step up readiness to prevent, detect and respond to disease outbreaks by addressing financing, prioritisation and management.

Financing

Disease outbreaks are both lethal and costly. During 1997–2009, economic losses from six major outbreaks averaged $6.7 billion per year, and the cost of the 2014–2016 Ebola epidemic alone is estimated at $53 billion. Preparedness can prevent many outbreak-related costs, with estimated incremental worldwide expenditure of $4.5 billion per year needed to upgrade public health systems in low and middle-income countries, strengthen global institutions’ abilities to prevent and respond to emergencies, and invest in research and development of new vaccines, diagnostics and countermeasures for epidemic and pandemic-prone diseases.

Unfortunately, preparedness, although more effective and less costly than response, rarely ranks high on political agendas. Competing priorities for finite national budgets, along with the invisible outcome of successful preparedness, have resulted in little funding, despite an estimated 25%–88% annual return on investment. Vulnerable lower income countries have bigger gaps and greater need for external financing. Of the 24 least-prepared countries, 20 (83%) are sufficiently low income to be eligible for International Development Association (IDA18) from the World Bank. In these countries, there are limited resources and competing demands, with the result that public health is often a low priority. The World Bank has recently dedicated additional support for health security in these settings through specific IDA projects such as the Regional Disease Surveillance Systems Enhancement project. Regional development banks can develop similar credit or grant programmes to build public health capacity in countries and protect regions from the economic shocks of large-scale outbreaks, as the Asian Development Bank has done.

Prioritisation

Stepping up preparedness is difficult, and requires that many incremental activities be done to achieve meaningful change. This is nearly impossible without prioritisation, and countries need coherent guidance and practical tools to identify where to begin. To reduce epidemic risk, countries must ensure prioritisation of core capacities of laboratory, surveillance, workforce and emergency response operations, as well as critical enabling areas including emergency preparedness, risk communications, and national legislation, policy and financing.

Countries can use information collected from JEEs, annual self-evaluations of preparedness, risk assessments and evaluations of real and simulated events to identify specific vulnerabilities and urgent actions to take next. Recently, the WHO and partners developed a library of key sequential activities necessary for countries to move from one preparedness level to the next. By combining practical technical guidance with improved prioritisation, countries can move more rapidly from assessment to improvement.

Management

Preparedness activities are implemented by the government, often supported by donors, bilateral and non-governmental organisations. Donors and governments often prefer tangible and highly visible support, such as building Emergency Operations Centers, without means to support ongoing operational costs and human resource requirements. By focusing on specific key activities informed by preparedness assessments, partners can help build the basic systems necessary to find, stop and prevent disease outbreaks. Unless partners also support management, human resources and strengthening of administrative systems, many countries are unlikely to efficiently and effectively implement plans. Strengthening management, improving technical expertise and advocating for increased long-term domestic financing should be a part of every engagement. Leadership and management skills are essential to planning and implementation, but their development is often eclipsed by a focus on more ‘technical’ skills.

Management within health systems is particularly important in low-income settings, where efficient use of limited resources is critical to accomplish health goals. Those charged with leading preparedness activities need effective tools and skills to plan, implement and report on complex multisector National Action Plans for Health Security (NAPHS) across all 19 technical areas. On average, it has taken 420 days for countries to conduct a JEE and then release a finalised NAPHS, which is not yet linked to resource mobilisation. Cumbersome and lengthy planning processes not effectively linked to resource mobilisation have hindered implementation of gap-filling activities.

To develop expertise in preparedness, the routine evaluation of detection and response performance in real or simulated events should be common practice. Use of after-action reviews,14 and, where necessary, robust simulation exercises, as well as monitoring the timeliness of outbreak detection, response and control15 enables countries to strengthen systems for an unusual or larger event. These reviews can also help identify bottlenecks to effective response, such as inadequate community engagement and geographic or demographic groups that distrust government action which may require concerted, long-term efforts to address.

At the onset of the West Africa Ebola epidemic in 2014, most countries did not have Public Health Emergency Operations Centers (PHEOC). Since then, more than 20 such centres have been established in Africa, with substantial support from regional and international partners. Unfortunately, many of these structures are not fully functional and lack key components, including information management systems and full-time, trained staff. Many PHEOCs are used primarily as spaces to conduct large meetings, with a high threshold for activation leading to underutilisation. Emergency response capacity, including emergency operations centres, will be most effective if used regularly for a broad spectrum of events, ranging from everyday ‘watch’ activities including disease surveillance, resource management and functional exercising, to response, including incident management and coordination of response to outbreaks and other health hazards.

Conclusion

Health cannot be protected by Ministries of Health alone. Many sectors need to be involved in order to increase and sustain investment, build long-term capacity and implement policies affecting health in the food, security and animal sectors. In many countries, the JEE was the first opportunity for these sectors to work together. This group should continue to collaborate in order to prioritise which gaps to fill first, begin implementation, increase domestic financing and monitor progress. High-level support (eg, from presidential or prime minister offices) is essential for countries to take action. Engagement by journalists and civil society can convey that increased health security is essential. This support can help counter the pattern of a temporary surge of activity followed by waning interest, as typically seen after a major outbreak.

For the first time in history, the world has an in-depth understanding of how prepared most countries are to deal with epidemic diseases and of what must be done to improve preparedness. To save lives, funded, prioritised, well-planned actions must be implemented at scale as soon as possible, supported by a network of partners working together to support countries to step up their capacities to prevent, detect and respond to public health threats and make the world safer.

• Health workers were differentially infected during the 2014 to 2016 Ebola outbreak with an incidence rate of 30 to 44/1000 depending on their job duties, compared to the wider population’s rate of 1.4/1000, according to the WHO.

• Médecins Sans Frontières (MSF) health workers had a much lower incidence rate of 4.3/1000, explained as the result of MSF’s ‘duty of care’ toward staff safety.

• Duty of care is defined as an obligation to conform to certain standards of conduct for the protection of others against an unreasonable risk of harm.

• The duty of care was operationalised through four actions: performing risk assessments prior to deployment, organising work and work practices to minimise exposure, providing extensive risk communication and training of staff and providing medical follow-up for staff exposures.

• Prioritising staff safety by taking such actions will help avoid the catastrophic loss of the health work force and assist in building resilient health systems.

Given the longstanding 5% rate of Ebola infection in DR Congo healthcare workers, MSF and the Congolese authorities have failed to communicate these principles to HCWs in Ituri and the Kivus. Perhaps many of the infected workers were staff of traditional health workers. But it remains a notable lapse in an otherwise sophisticated response.

Geneva, Switzerland- The Iman Obstetrics and Gynecology Hospital in Orum Al Kubra in the Aleppo countryside was targeted today, August 31, 2019, by seven airstrikes at 1 a.m. Damascus time. The hospital was damaged and put out of service. No casualties were reported but two patients and one staff were injured. Newborn babies that were still in incubators had to be evacuated.

This marks the 50th medical facility to be targeted since April 28. At least 10 of those hospitals, including Alzerbeh Hospital attacked yesterday, were deconflicted with coordinates provided to the UN.

Dr. Khaula Sawah, Vice President of UOSSM USA said, “Seeing pictures of newborn babies being evacuated from a hospital they were just born in is absolutely unacceptable. These war crimes cannot continue to happen with no consequences. We call on the international community to intervene and take action such as the UNGA 'Uniting For Peace' Resolution. I have no words…. hospitals are not a target.”

Since April 28, 2019:

At least 892 civilians have been killed including at least 226 children and 179 women.

Over 1912 civilians have been injured.

Over 750,000 people have been internally displaced in North Western Syria.

50 medical facilities have been bombed, 30 aid workers have been killed and 40 have been wounded.

Five ambulances were hit by different airstrikes while serving patients, killing eight staff.

The former Attorney General, Oly Ilunga Kalenga, was told by the Prosecutor General's Office of the Kinshasa Court of Cassation with three of his former advisers that he would be "banned from leaving the country" until further notice.

This is what reveals a document called "Message" dated 31 August 2019 from the Directorate General of Migration (DGM) circulating on social networks and AFRIWAVE.COM has read.

The text and signature states: "Order of the hierarchy, the name Oly Ilunga Kalenga, honorary Minister of Health in the DRC, to be banned from leaving the national territory, wide dissemination."

A second document apparently signed on the same date adds the names of former collaborators of Dr. Ilunga who are subject to the same measure of prohibition to leave the territory. They are Mukendi Nyembo Olivier, Mbuyi Mwase Ezekiel, Ernest Mbo Ilenge.

Contacted anonymously, a security officer in charge and an expert in defense and security methods both explain that "the language used in this document proves its authenticity"; so much the "false" has been challenged in recent hours in other similar cases of so-called "official" documents.

Coming from Belgium where he worked as Director of Clinics and where his family still resides, Dr. Oly Ilunga had nevertheless emerged free and without questioning his hearing at the beginning of the week, despite the "custody" of his former employees.

If this prohibition of exit from territory proves to be correct, the opinion wonders what the investigators could discover in the file on the "management of the funds allocated to the response to the Ebola virus disease when Oly Ilunga was charge."

SAN ANTONIO, TEXAS — It took Julia and her two daughters five years to get from Kassai, in the Democratic Republic of Congo, to a cot on the floor of a migrant shelter in Laredo, Texas, on a Sunday night in August 2019.

First, it was four years in Angola. She saved money, she says, by working as a hairdresser.

They flew to Ecuador. Took a bus and boat to Colombia. They spent 14 days crossing through Panama’s Darien Gap, lost part of the time in the dense jungle. Three weeks in Panama, then three more in Costa Rica while Julia recuperated from an illness. Then Nicaragua. Honduras. Guatemala.

Finally, after a month of waiting in Acuña, on the U.S.-Mexico border, they stuck their feet in the sandy dirt along the southern bank of the Rio Grande. They were alone, and didn’t know how to swim.

“We prayed first, then we got into the water,” Julia recalled. “My daughter was crying.”

Historically, the majority of people caught crossing into the southwest U.S. without authorization were single Mexican adults. In fiscal 2009, Mexicans accounted for 91.63% of border apprehensions, according to U.S. Customs and Border Protection data.

But demographics of migrants and asylum-seekers crossing into the U.S. from Mexico are shifting in two significant ways: In the last decade, nationals of El Salvador, Guatemala and Honduras began migrating in greater numbers. In the same period, the number of Mexicans dropped.

Then, in the last year, families became the top source of Southwest border migration. The Border Patrol apprehended 432,838 adults and children traveling in family units from October 2018 through July 2019, a 456% increase over the same period the previous fiscal year.

To the surprise of longtime border agents, while the overwhelming majority of these families continue to be from Mexico and the Northern Triangle countries of Central America, a small but growing proportion are from countries outside the Americas, nearly twice as many as two years ago.

By the end of July this year, CBP data shows the agency had apprehended 63,470 people from countries other than those four, making up 8.35% of total apprehensions. In fiscal 2017, they were 4.3% of the total apprehended population.

CBP does not release the breakdown of where detained migrants come from until after the end of the fiscal year in September. But anecdotes and preliminary data show an increasingly diverse group of migrants and asylum-seekers, including more than 1,600 African nationals from 36 countries, apprehended in one border sector alone.

They are unprecedented numbers.

Allen Vowell, an acting deputy patrol agent in charge with the U.S. Border Patrol in Eagle Pass, Texas, said the recent demographic changes are unlike any he has seen in two decades of working on the border.

“I would say until this year, Africans — personally I’ve probably only seen a handful in over 20 years,” Vowell said.

Ministry of Health on Friday delivered 300 doses of Ebola vaccine to Kasese, after a nine-year-old girl succumbed to the deadly hemorrhagic fever at Bwera Ebola Treatment Unit yesterday.

Dr Joyce Moriku Kaducu the State Minister for Primary Health Care said the vaccines are to be used to vaccinate any possible contacts of the deceased.

On Thursday, the Ministry of Health confirmed an Ebola Case of a nine-year-old female of Congolese origin who travelled from the Democratic Republic of Congo (DRC) with her mother on Wednesday, 28th August.

The girl died early Friday Morning. Upon the request of the father for the daughter to have a safe and dignified burial, the body has been taken back to DRC, as well as the mother.

António Guterres, Secretary-General of the United Nations, arrived this Saturday in Goma. This is the first stage of a three-day visit that will also take him to Beni and Kinshasa.

"There are major concerns about health. There is measles, malaria, cholera and now terrible drama of Ebola. We are fully on the side of the Congolese authorities and the Congolese people to try to meet all these challenges. I reaffirm that this visit is a solidarity visit to express my admiration to the Congolese people and especially to the people of North Kivu," he said in his brief communication arriving in Goma.

Declared officially in the DRC last June, the current measles epidemic is the deadliest that the country has seen since 2011. More than 3,000 people have died since January 2019. The epidemic affects all 26 provinces of the country since the beginning of 2019 with more than 161,397 suspected cases, including 3,117 deaths (CFR: 1.9%).

The other health challenge is Ebola. Since the beginning of the epidemic, the cumulative number of cases is 3,017, of which 2,912 are confirmed and 105 are probable. In total, there were 2,015 deaths (1,910 confirmed and 105 probable) and 902 people healed. Current efforts to find funding for the Fourth Strategic Ebola Response Plan (SRP4).

In Goma, the UN chief will meet Ebola survivors and health workers engaged in the response to the virus. He will also visit an Ebola treatment center before traveling to Beni.

CMRE has emailed its August 30 update, with data for August 29. Excerpt from the Google translation:

SUBJECT: EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI AS AT AUGUST 29, 2019.

Date: Friday, August 30, 2019

Since the beginning of the epidemic, the cumulative number of cases is 3,017, of which 2,912 are confirmed and 105 are probable. In total, there were 2,015 deaths (1,910 confirmed and 105 probable) and 902 people healed.

• 399 suspected cases under investigation;

• 13 new confirmed cases, including:

º 9 in North Kivu, including 3 in Mutwanga, 2 in Kalunguta, 1 in Beni, 1 in Butembo, 1 in Katwa and 1 in Musienene;º 4 in Ituri, including 3 in Mambasa and 1 in Mandima.

• 9 new confirmed deaths, including 3 in North Kivu and 1 in Ituri:

º 5 community deaths, including 2 in North Kivu, including 1 in Katwa and 1 in Beni, and 3 in Ituri, including 2 in Mambasa and 1 in Mandima

º 4 deaths in the CTE in North Kivu, including 3 in Butembo and 1 in Beni;

• No healed person left the ETC;

• No health workers are among the newly confirmed cases. The cumulative number of confirmed/probable cases among health workers is 156 (5% of all confirmed/probable cases), including 41 deaths.

/!\ The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas.

NEWS

Congolese case confirmed with the EVD registered in Uganda deceased this Friday

• The confirmed case in the city of Kasese in Uganda died on Friday, August 30, 2019 at the transit center (CT) in Uganda;

• This is a 9-year-old girl residing in the Lubiriha Health Area (Majengo) located in Mutwanga Health Zone in North Kivu Province, Democratic Republic of Congo;

• She was co-patient of a deceased case and confirmed on 16 August 2019 at Umoja health post, during the period from 10 - 16 August 2019, who refused to be followed or to be vaccinated;

• This child was brought to Uganda by her mother on August 28, 2019 after reoccurrence of fever associated with asthenia and diarrhea, while from the 24th to the 27th of the same month she was seen outpatient at the Sinai Pamusi clinic with a slight improvement;

• Intercepted on 28 August 2019 at the Ugandan port of Mpodwe, the child was transported to the Ugandan Transit Center in Kasese, where a sample was taken on 29 August 2019 with confirmation of EVD.

• The information did not reach the Congolese response teams until the day of Thursday, August 29, 2019. As soon as informed, the team of the general coordination to the response to the EVD held a meeting of crisis at the end from which arrangements were made for its assumption of responsibility;

• This child died on August 30, 2019;

• In total, 50 contacts are listed in Lubiriha around this case, including 7 Frontline People (PPL). Investigations are in progress.

Two recommendations from the training of trainers on the preparation of the EVD response in the city of Kinshasa

• Two major recommendations were made during the training of trainers on the preparation of the Ebola Virus Disease (EVD) response in the city of Kinshasa.

• This is the training of health care providers and regular simulation exercises to prepare to intercept and quickly stop possible Ebola suspected cases that could occur in the city of Kinshasa, said the Deputy Director of the National Program Border Hygiene, Dr. Billy Yumayine;

• For the national coordinator of the preparation of the EVD response in the city of Kinshasa, Dr. Body Ilonga, after this training of national trainers, it would be necessary to support provinces, whose first two targeted are the Tshopo and Kinshasa . To this end, it has given two orientations for the implementation of the recommendations, namely: with regard to training, providers have already been targeted at entry points and training will start next week with the support of JICA, IOM in collaboration with the city of Kinshasa Province. For simulation, there will be two scenarios at the airport upon arrival and / or boarding of passengers and at the community level;

• The Japan Agency for International Cooperation (JICA) Country Representative, Shibata Kazunao, welcomed this training, which not only increased the critical mass of actors in terms of rapid response team, but also terms of trained trainers capable of sharing and enriching, on a large scale, the know-how and know-how characterizing the Congolese experience of Ebola Virus Disease.

• Long before, participants in this training were subjected to hand hygiene and waste management exercises, disinfection of means of transport, other soiled surfaces and standards for disinfection of aircraft. They have also been recycled to the correct and proper wearing of personal protective equipment (PPE);

• Communication on emergency risks and community engagement was also part of the lessons learned by these participants;

• It should be recalled that this training was organized as part of the WHO declaration on 17 July 2019 in Geneva of this 10th Ebola Virus Disease epidemic in the DRC as a public health emergency of international concern.

VACCINATION

• Since the beginning of vaccination on August 8, 2018, 208,321 people have been vaccinated;

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 20 May 2018.

MONITORING AT ENTRY POINTS

• Since the beginning of the epidemic, the cumulative number of travelers checked (temperature rise) at sanitary control points 89,958,698;

• To date, a total of 98 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

August 30, 2019

The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard, published earlier than usual today, reports 13 new cases on August 29, with 40 so far this week, 204 in the past 21 days, and 3,016 since the outbreak was declared. The Ebola death toll is now 2,005, and 902 have recovered. Out of 17,400 contacts, 1,800 are going untraced.

Also of note tonight, Helen Branswell reports that the 9-year-old Congolese girl who died of Ebola in Bwera, Uganda, came from Mutwanga health zone, an hour's drive from Bwera. Beni is just a little farther away, but it's had so many cases, and so many deaths, that the girl's mother may well have decided that Bwera was a safer bet.